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PubMedDate not supplied

Intravenous ketorolac as an adjunct to patient-controlled analgesia (PCA) for management of postgynecologic surgical pain.

STUDY OBJECTIVE: To determine whether intravenous (IV) doses of ketorolac tromethamine provide safe and effective augmentation of postsurgical analgesia for patients using IV patient-controlled analgesia (PCA) with morphine. DESIGN: Randomized, double-blind, placebo-controlled, dose-response evaluation. SETTING: Patient care unit at a university medical center. PATIENTS: 62 ASA physical status I-III females recovering from intra-abdominal gynecologic surgery with general anesthesia who requested postoperative PCA. INTERVENTIONS: Following initial pain assessment in the recovery room, patients were randomized to receive either IV saline (placebo) followed by IV saline every 6 hours (Group 1); IV ketorolac 30 mg loading dose followed by IV ketorolac 15 mg every 6 hours (Group 2); or IV ketorolac 60 mg loading dose followed by IV ketorolac 30 mg every 6 hours (Group 3). All patients were provided IV PCA, which was programmed to provide 1.2 mg of morphine with a 6-minute lockout interval. MEASUREMENTS AND MAIN RESULTS: Visual analog scale (VAS) resting pain and satisfaction scores were measured every 2 to 12 hours. Cumulative PCA with morphine and the frequency and severity of side effects also were assessed. IV ketorolac showed no clinically significant side effects. Group 2 patients experienced significant reductions in VAS resting pain scores (p < 0.05), and a trend toward decreased morphine self-administration in both active groups was noted. Group 2 and Group 3 patients reported greater satisfaction with postsurgical analgesia than Group 1 patients. (p < 0.05). CONCLUSIONS: IV ketorolac used as an analgesic adjunct provided safe and effective augmentation of PCA with morphine in patients recovering from intra-abdominal gynecologic surgery.

Adult↗

PubMed1986

Tension-pCa relations of saponin-skinned rabbit and human heart muscle.

We tested if interaction between the thick and thin filaments, as revealed by the rate of cross-bridge cycling or the pattern of calcium activation, influences the relation between tension and free calcium concentration (pCa) of cardiac muscle. Bundles of rabbit ventricular cells which contained either fast-cycling RV1 myosin or slowly-cycling RV3 myosin and bundles of human atrial cells were chemically skinned by exposure to saponin. Skinned bundles were rapidly activated with calcium using the method of Moisescu and Thieleczek (1978). Our results suggest that the relation between pCa and tension is not different for skinned bundles of rabbit ventricular cells that contain either fast or slowly cycling myosin cross-bridges. The pattern of calcium activation, i.e. maximal to submaximal or submaximal to maximal, was also found not to influence the relation between tension and pCa for either rabbit ventricular or human atrial muscle. The tension-pCa relation of cardiac muscle was not altered by conditions that have been shown to alter the tension-pCa relation of skeletal muscle. These results suggest that the mechanisms responsible for regulating force development at the level of the thick and thin filaments that have been reported for skeletal muscle, are absent in cardiac muscle.

Animals↗

PubMed2005

Racemic monoperoxovanadium(V) complexes with achiral OO and ON donor set heteroligands: synthesis, crystal structure and stereochemistry of [NH3(CH2)2NH3][VO(O2)(ox)(pic)].2H2O and [NH3(CH2)2NH3][VO(O2)(ox)(pca)].

Monoperoxovanadium(V) complexes, [NH3(CH2)2NH3][VO(O2)(ox)(pic)].2H2O (1) and [NH3(CH2)2NH3][VO(O2)(ox)(pca)] (2) [NH3(CH2)2NH3 = ethane-1,2-diammonium(2+), ox=oxalate(2-), pic=pyridine-2-carboxylate(1-), pca=pyrazine-2-carboxylate(1-)], were synthesized and characterized by X-ray analysis, IR and Raman spectroscopies. The five equatorial positions of the pentagonal bipyramid around the vanadium atoms are occupied by the eta2-peroxo ligand, two oxygen atoms of the ox, and the nitrogen atom of the pic or pca ligands, respectively. The oxo ligand and the oxygen atom of pic or pca are in the axial positions. Networks of X-HO (X=C, N or O) hydrogen bonds, and pi-pi interactions between aromatic rings in and anion-pi interactions in , determine the molecular packings and build up the supramolecular architecture. Three stereochemical rules for occupation of the donor sites in two-heteroligand [VO(O2)(L1)(L2)] complexes (L1, L2 are bidentate neutral or differently charged anionic heteroligands providing an OO, NN or ON donor set) are discussed. and crystallize as racemic compounds. The 51V NMR spectra proved that the parent complex anions of and partially decompose on dissolution in water to the monoperoxo-ox, -pic or -pca complexes.

Ammonia↗

PubMed1997

[Effectiveness, side effects and costs of postoperative pain therapy: intravenous and epidural patient-controlled analgesia (PCA)].

PURPOSE: Improvement of the quality of analgesia, reduction of side effects and costs by application of epidural (PCEA) in comparison to intravenous patient-controlled analgesia (PCA) in postoperative pain treatment. METHODS: 62 patients with upper abdominal surgery took part in this randomised prospective study which was approved by the local ethics committee. Epidural catheters were inserted at T 8/9 (group PCEA). General anaesthesia was performed with propofol, sufentanil 2 micrograms/kg, pancuronium, enflurane and O2:N2O = 1:2. Postoperative analgesia consisted of epidural bupivacaine 0.25% + sufentanil 2 micrograms/ml (BS). (bolus 0.05 ml/kg, lockout 10 min) in group PCEA, or of intravenous morphine (bolus 2 mg. lockout 10 min) in group PCA. The following parameters were recorded until the evening of postoperative day 4: pain intensity at rest (VASR, 1-10) and on coughing (VASH, 1-10), blood pressure, heart rate, blood gas analysis, ability to ambulate, pruritus, nausea/vomiting (PONV), patient satisfaction (0-4), time and expenses for postoperative pain treatment. RESULTS: Median VASR (1 vs 2) and VASH (3 vs 4.5) were lower, cough intensity (2 vs 1) and patient satisfaction score (4 vs 3) were higher in PCEA compared to PCA. Ability to ambulate, pruritus, PONV, haemodynamics, paO2 and paCO2 were comparable. Postoperative pain treatment with PCEA was more time-consuming (407 vs 299 min) and expensive (71 vs 40 S/day) than PCA. CONCLUSION: PCEA in comparison to PCA after major abdominal surgery provides superior analgesia with comparable side effects at approximately 80% higher costs.

Abdomen↗

PubMedDate not supplied

[Arthroplasty using the PCA (porous coated anatomic) knee joint].

A review on the experience and the results with 184 PCA (Porous Coated Anatomic)-knee endoprostheses is given, performed at the Department of Orthopaedic Surgery, Basel, from 1981 to 1984 with an observation period of 6 months to 3 1/2 years. The PCA-knee endoprosthesis will be described and the special surgical technique will be presented. It's possible to implant the PCA-knee endoprosthesis without cement. 60% of our 184 prostheses were inserted without cement, in 19% it was used partially. In 29 of our cases an implantation was performed in both knees at one stage. The PCA-knee-joint is not constrained. It was necessary to perform corrections of the active and passive knee-stabilisators in 28%, a lateral release was performed in 85%. The postoperative flexion reached on an average 95 degrees (+/- 16.7), the deficit of extension 2 degrees (+/- 4) in opposition to 11 degrees (+/- 9) preoperatively. A severe medial instability of ligaments was found postoperatively just in one case, a slight one in 11 cases and a severe lateral instability in one case. Drawer-instability was found only in 5 patients (3 anterior, 2 posterior). 70% of our patients with an average age of 74 years were able to walk postoperatively more than one kilometre (preoperatively 8%) and more than 50% walked without crutches. Postoperative infections occurred in three cases (1.5%), requiring an arthrodesis, a revision and a withdrawal. No complications arose in 86.5%, the most common was found at the patella (9.5%). Based on increasing experiences this complication could also be almost eliminated. We estimate the implantation of the PCA-knee endoprosthesis as recommandable taking care of correct indication and a careful surgical technique.

Aged↗

PubMed1986

Effects of partial extraction of troponin complex upon the tension-pCa relation in rabbit skeletal muscle. Further evidence that tension development involves cooperative effects within the thin filament.

Partial extraction of troponin C (TnC) decreases the Ca2+ sensitivity of tension development in mammalian skinned muscle fibers (Moss, R. L., G. G. Giulian, and M. L. Greaser. 1985. Journal of General Physiology. 86:585), which suggests that Ca2+-activated tension development involves molecular cooperativity within the thin filament. This idea has been investigated further in the present study, in which Ca2+-insensitive activation of skinned fibers from rabbit psoas muscles was achieved by removing a small proportion of total troponin (Tn) complexes. Ca2+-activated isometric tension was measured at pCa values (i.e., -log[Ca2+]) between 6.7 and 4.5: (a) in control fiber segments, (b) in the same fibers after partial removal of Tn, and (c) after recombination of Tn. Tn removal was accomplished using contaminant protease activity found in preparations of LC2 from rabbit soleus muscle, and was quantitated using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and scanning densitometry. Partial Tn removal resulted in the development of a Ca2+-insensitive active tension, which varied in amount depending on the duration of the extraction, and concomitant decreases in maximal Ca2+-activated tensions. In addition, the tension-pCa relation was shifted to higher pCa values by as much as 0.3 pCa unit after Tn extraction. Readdition of Tn to the fiber segments resulted in the reduction of tension in the relaxing solution to control values and in the return of the tension-pCa relation to its original position. Thus, continuous Ca2+-insensitive activation of randomly spaced functional groups increased the Ca2+ sensitivity of tension development in the remaining functional groups along the thin filament. In addition, the variation in Ca2+-insensitive active tension as a function of Tn content after extraction suggests that only one-third to one-half of the functional groups within a thin filament need to be activated for complete disinhibition of that filament to be achieved.

Animals↗

PubMed1989

Oxyhemoglobin saturation following cesarean section in patients receiving epidural morphine, PCA, or im meperidine analgesia.

The frequency and severity of oxyhemoglobin desaturation was compared in 49 patients receiving epidural morphine, 5 mg (n = 21); patient-controlled analgesia (PCA) using meperidine (n = 20); or intramuscular (im) meperidine (n = 8) for postoperative analgesia following elective cesarean section performed with epidural anesthesia. Oxygen saturation (SpO2) was monitored for 24 h using a pulse oximeter; data were continuously collected and stored every 30 s via an interface connected to a computer. For analysis purposes, SpO2 was divided into five categories: 96-100%, 91-95%, 86-90%, 81-85%, and less than or equal to 80%. Although SpO2 remained above 95% for the majority of the monitored period, patients in all groups experienced periods of desaturation. PCA patients spent the longest cumulative time with SpO2 between 91 and 95%, 231 +/- 49 min (mean +/- SEM), compared with only 112 +/- 30 min and 152 +/- 42 min for the epidural and im groups, respectively (P less than 0.05 vs. epidural group). PCA patients also spent longest with SpO2 at 86-90% (19 +/- 10 min, vs. 6 +/- 3 and 0.5 +/- 0.3 min for the epidural and im groups, respectively), although this difference was not statistically significant. Severe desaturation episodes, defined as SpO2 less than or equal to 85% for more than 30 s, occurred in 71% of patients in the epidural group, 30% in the PCA group, and 63% in the im group (P less than 0.05 PCA vs. epidural and im).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Children's use of PCA following spinal fusion.

PURPOSE: The purpose of this study was to examine the effectiveness of patient-controlled analgesia (PCA) in relieving postoperative pain for children and adolescents following spinal fusion. DESIGN/SAMPLE: A one-group, descriptive design was used with a convenience sample of 93 children (ages 8 to 21 years) who had undergone spinal fusion over a 2-year period. METHODS: All of the patients were using PCA postoperatively with morphine sulfate, the most common opioid analgesic prescribed for use in the infusion pump. Data were collected for the first 4 postoperative days on four outcome variables: use of PCA, self-report of pain, observed pain-related behaviors, and satisfaction with PCA. FINDINGS: Despite aggressive pain management, findings showed that neither children's pain nor their analgesic use diminished significantly over time. Children continued to report moderate-to-severe pain over the 4-day measurement period. Likewise, children reported their satisfaction with PCA for pain relieve as "fair" to "good." CONCLUSION: The use of high technology and aggressive pharmacologic treatment alone may not be adequate for managing severe pain following spinal fusion. As proposed by the Gate Control Theory, pain stimuli produce not only physiologic, but also psychologic and emotional responses. Relief for severe pain, therefore, may require multidimensional therapies that include nonpharmacologic approaches together with precise titration of available pharmacologic agents.

Adolescent↗

PubMed1988

Cloning and expression of pca genes from Pseudomonas putida in Escherichia coli.

Beta-Ketoadipate elicits expression of five structural pca genes encoding enzymes that catalyse consecutive reactions in the utilization of protocatechuate by Pseudomonas putida. Three derivatives of P. putida PRS2000 were obtained, each carrying a single copy of Tn5 DNA inserted into a separate region of the genome and preventing expression of different sets of pca genes. Selection of Tn5 in or near the pca genes in these derivatives was used to clone four structural pca genes and to enable their expression as inserts in pUC19 carried in Escherichia coli. Three of the genes were clustered as components of an apparent operon in the order pcaBDC. This observation indicates that rearrangement of the closely linked genes accompanied divergence of their evolutionary homologues, which are known to appear in the order pcaDBC in the Acinetobacter calcoaceticus pcaEFDBCA gene cluster. Additional evidence for genetic reorganization during evolutionary divergence emerged from the demonstration that the P. putida pcaE gene lies more than 15 kilobase pairs (kbp) away from the pcaBDC operon. An additional P. putida gene, pcaR, was shown to be required for expression of the pca structural genes in response to beta-ketoadipate. The regulatory pcaR gene is located about 15 kbp upstream from the pcaBDC operon.

Cloning, Molecular↗

PubMed2005

Clustered blockwise PCA for representing visual data.

Principal Component Analysis (PCA) is extensively used in computer vision and image processing. Since it provides the optimal linear subspace in a least-square sense, it has been used for dimensionality reduction and subspace analysis in various domains. However, its scalability is very limited because of its inherent computational complexity. We introduce a new framework for applying PCA to visual data which takes advantage of the spatio-temporal correlation and localized frequency variations that are typically found in such data. Instead of applying PCA to the whole volume of data (complete set of images), we partition the volume into a set of blocks and apply PCA to each block. Then, we group the subspaces corresponding to the blocks and merge them together. As a result, we not only achieve greater efficiency in the resulting representation of the visual data, but also successfully scale PCA to handle large data sets. We present a thorough analysis of the computational complexity and storage benefits of our approach. We apply our algorithm to several types of videos. We show that, in addition to its storage and speed benefits, the algorithm results in a useful representation of the visual data.

Algorithms↗

PubMed1996

Patient controlled analgesia (PCA) in paediatric surgery: a prospective study following laparoscopic and open appendicectomy.

Patient controlled analgesia (PCA) has not yet gained universal acceptance for the management of postoperative pain in paediatric surgery. In a prospective study we evaluated feasibility and complications of PCA following 90 cases of laparoscopic or open appendicectomy. PCA proved to be a safe and feasible method with few complications (2% of medical complications, no abort of application, 17 technical checks in a total running time of 4125 h). Acceptance by patients was high and children of all age groups worked the system properly. Assessment of application protocols showed, that the consumption of analgesics was significantly reduced following laparoscopic appendicectomy (P < 0.05). PCA is a safe and feasible method for the management of postoperative pain in children and PCA recording provides an excellent insight into the consumptional behaviour of patients, enabling staff to evaluate postoperative pain for various procedures.

Analgesia, Patient-Controlled↗

PubMed1987

Cloning and genetic organization of the pca gene cluster from Acinetobacter calcoaceticus.

The beta-ketoadipate pathway of Acinetobacter calcoaceticus comprises two parallel metabolic branches. One branch, mediated by six enzymes encoded by the cat genes, converts catechol to succinate and acetyl coenzyme A (acetyl-CoA); the other branch, catalyzed by products of the pca genes, converts protocatechuate to succinate and acetyl-CoA by six metabolic reactions analogous or identical to those of the catechol sequence. We used the expression plasmid pUC18 to construct expression libraries of DNA from an A. calcoaceticus mutant strain from which the cat genes had been deleted. Immunological screening with antiserum to the pcaE gene product, beta-ketoadipate:succinyl-CoA transferase I, resulted in the isolation of a cloned 11-kilobase-pair (kbp) fragment which inducibly expressed all six pca genes under control of the lac promoter on pUC18. The induced Escherichia coli cells formed the six pca gene products at levels 10- to 30-fold higher than found in fully induced A. calcoaceticus cultures, although protocatechuate 3,4-dioxygenase (the iron-containing product of the pcaA gene) from the recombinant strain possessed a relatively low turnover number. An E. coli culture expressing the cloned pca genes quantitatively converted protocatechuate to beta-ketoadipate; failure of the organism to metabolize the latter compound can be most readily ascribed to relatively low pool levels of succinyl-CoA, a required substrate for beta-ketoadipate:succinyl-CoA transferase, in E. coli. The gene order and direction of transcription were determined to be pcACBDFE by identification of enzymes expressed in subclones, by using natural transformation to identify subclones carrying DNA corresponding to dysfunctional alleles in mutant A. calcoaceticus strains, and by restriction mapping of both the 11-kbp fragment and derivatives of the 11-kbp fragment containing Tn5 in the pcaA, pcaB, pcaD, and pcaE genes. The fragment containing the pca gene hybridized strongly and specifically to a previously cloned fragment containing A. calcoaceticus cat genes.

Acinetobacter↗

PubMed1979

Interaction among IgE-mediated hypersensitivity reaction, PCA reaction and delayed hypersensitivity reaction (at local skin sites of monkeys).

The effect of the IgE-mediated reaction on the passive cutaneous anaphylaxis (PCA) reaction was studied at local skin sites of monkeys, and we found that the IgE-mediated reaction appeared to enhance the PCA reaction. Interactions among IgE-mediated reaction, PCA reaction and delayed hypersensitivity reaction were also determined. Contact dermatitis induced with DNCB was utilized as the delayed hypersensitivity reaction. The IgE-mediated reactior or PCA reaction, as well as simple serum irritation, enhanced the delayed hypersensitivity reaction. It is thus assumed that the IgE-mediated reaction enhances the PCA reaction and that this in turn accelerates the delayed hypersensitivity reaction.

Animals↗

PubMed2001

Effects of the 5-HT2 receptor antagonist, ritanserin on hyperthermia and depletion of 5-HT in frontal cortex induced by a 5-HT releasing drug, p-chloroamphetamine (PCA) in mice.

Effects of the 5-HT2 receptor antagonist, ritanserin on hyperthermia and depletion of 5-HT induced by the 5-HT-releasing drug, p-chloroamphetamine (PCA) were investigated. Ritanserin significantly suppressed PCA-induced hyperthermia in mice. PCA elicited decreases in 5-HT levels in the mouse frontal cortex. 5-HT reduction elicited by PCA was also attenuated by pretreatment with ritanserin. Since hyperthermia facilitates neurotoxicity induced by amphetamine analogue, ritanserin may inhibit PCA-induced 5-HT neurotoxicity by inhibiting hyperthermia.

Animals↗

PubMedDate not supplied

The human posterior cricoarytenoid (PCA) muscle and diaphragm. A histochemical comparison as a basis for reinnervation attempts.

PCA (posterior cricoarytenoid) muscles and biopsies from the SCM (sterno-cleidomastoid) muscles as well as the diaphragm were serially sectioned and incubated for myofibrillar ATPase and selected metabolic enzymes. The three main fibre types were present in all muscles, although some PCA muscles seemed to lack IIB fibres. The mean fibre type pattern of the PCA muscle was 57% type I, 36% type IIA and 7% type IIB, as compared with 42% type I, 42% type IIA and 16% type IIB in the diaphragm. All fibre types of the PCA muscle and the diaphragm were significantly more oxidative and less glycolytic than the corresponding SCM muscle fibres. Most striking was the finding of high 3-HBDH activity in the PCA and diaphragm muscle fibres, especially in type I.

Adenosine Triphosphatases↗

PubMedDate not supplied

Pain control: patient and staff perceptions of PCA.

In the United Kingdom, patient controlled analgesia (PCA) has been used primarily as a research tool and its place in the treatment of postoperative pain is only slowly being established. The concept of patients being able to control their own pain relief is therefore new to staff and patients. In this study, a small part of a larger study concerned with the personality characteristics and the effectiveness of PCA which formed the basis of the author's PhD research, 70 patients who had used PCA for postoperative pain relief, and 20 nursing and anaesthetic staff, completed a questionnaire about PCA. The results showed a high level of enthusiasm for PCA among all categories of respondents.

Analgesia, Patient-Controlled↗

PubMed2000

[PCA in the control of acute and chronic pain in children].

BACKGROUND: This study was undertaken to verify the efficacy and safety of patient controlled analgesia (PCA) in preschool and older than 6 years children with acute postoperative and chronic oncologic pain. METHODS: Sixty-two children, aged 4-17 yr, with postoperative (n = 37) or chronic (n = 25) pain received PCA with morphine at the following dosages: bolus = 10-20 gamma kg-1; starter dose = 10-30 gamma kg-1; background infusion = 10-50 gamma kg-1 h-1. Lockout was 5 to 15 minutes. In some children with oncologic pathology adjuvant drugs were also used. RESULTS: Analgesia was considered satisfactory in all children, while a mild sedation was observed only in two children. PCA was also successfully used in preschool children (11%), aged 4 to 6 yr. Side effects were observed in 8 patients, but only in one of them a transient respiratory depression was recorded. The mean PCA duration was 5.3 +/- 5.5 days (min.2; max 24). CONCLUSIONS: These results indicate that PCA is an effective and safe method to control acute postoperative pain as well as to manage chronic oncologic pain in children.

Acute Disease↗

PubMed1992

Effects of the serotonin releasers 3,4-methylenedioxymethamphetamine (MDMA), 4-chloroamphetamine (PCA) and fenfluramine on acoustic and tactile startle reflexes in rats.

The substituted amphetamines 4-chloroamphetamine (PCA), 3,4-methylenedioxymethamphetamine (MDMA) and fenfluramine (FEN) share the common neurochemical action of acutely releasing central serotonin (5-HT), and yet their behavioral effects are quite different. The present study evaluated the effects of these compounds on acoustic and tactile startle reflexes. PCA and MDMA were qualitatively similar in producing dose-related increases in acoustic and tactile startle reflexes that were slow in onset, but sustained throughout the 3.5-hr test session. Changes in motor activity did not account for the observed excitation of startle. In marked contrast to MDMA and PCA, FEN did not alter tactile startle and tended to depress acoustic startle. The excitatory effect of 20 mg/kg of MDMA was prevented by the 5-HT uptake blockers MDL 27,777A and fluoxetine. MDMA excitation was not affected by a dose of the dopamine antagonist haloperidol that attenuated the startle-enhancing effect of d-amphetamine. MDMA excitation was greatly attenuated by a general depletion of central 5-HT produced by prior intraventricular injection of the 5-HT neurotoxin 5,7-dihydroxytryptamine. PCA and MDMA excitations of startle were attenuated in rats specifically depleted of spinal 5-HT or in rats with radio frequency lesions of the dorsal raphe nucleus. Thus, PCA and MDMA have similar prolonged excitatory effects on startle reflexes that are mediated by ascending (dorsal raphe) and descending (spinal) pathways, whereas FEN differs in its lack of excitation of startle. Differences in the neurochemical properties of these compounds or their patterns of 5-HT release may underlie their different behavioral profiles.

5,7-Dihydroxytryptamine↗